- Date2025-11-18
Publication of the 6th Pneumonia Adequacy Evaluation Results for 2023
- A total of 599 medical institutions nationwide were evaluated, with 311 institutions (51.9%) receiving Grade 1 -
□ The Health Insurance Review and Assessment Service (HIRA, President: Kang Jung-Gu) released the results of the 6th Pneumonia Adequacy Evaluation for 2023 on the 18th via the HIRA website* and mobile app**.
* HIRA website (www.hira.or.kr) > Medical Information > Medical Evaluation Information > Hospital Evaluation > Hospital Evaluation Search > Evaluation Category ‘Acute Diseases’ > Subcategory ‘Pneumonia’
** Mobile app (Health e-Eum) > HIRA Health Map > Hospital Evaluation Information > Evaluation Category ‘Other – Pneumonia’
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< Key Details of the 6th Pneumonia Adequacy Evaluation for 2023 >
▪Evaluation Target ◦ Evaluation Period: October 2023 – March 2024 (6 months) ◦ Institutions Evaluated: 599 medical institutions at the hospital level or higher with 10 or more admissions for community-acquired pneumonia during the evaluation period (46 tertiary hospitals, 304 general hospitals, 249 hospitals; long-term care hospitals excluded) ◦ Patients Evaluated: Adult patients aged 18 or older admitted for community-acquired pneumonia who received intravenous antibiotics for 3 days or more ▪Evaluation Results ◦ Overall Score: Average 82.9 points (tertiary hospitals 99.2, general hospitals 92.2, hospitals 66.8) ◦ Evaluation Grades: Grade 1 – 311 institutions (51.9%), Grade 2 – 123 institutions (20.6%), Grade 3 – 76 institutions (12.7%), Grade 4 – 44 institutions (7.3%), Grade 5 – 11 institutions (1.8%) *34 institutions (5.7%) with fewer than 10 cases during the evaluation period were excluded from grading |
□ Pneumonia is a serious disease that ranks as the third leading cause of death in Korea, following cancer and heart disease. Its mortality rate is particularly high among the elderly, making it a significant public health concern in an aging society.
○ In the 6th evaluation, 75.0% of patients were aged 60 or older, and among them, 32.3% were aged 80 or older, representing the largest proportion. The severity* distribution among patients aged 80 or older was 33.9% mild, 44.5% moderate, and 20.6% severe, highlighting the importance of pneumonia management in the elderly population.
*To determine the need for hospitalization and treatment, an objective scoring system is used. A representative severity assessment tool is the CURB-65 (scores 0–1: mild, 2: moderate, 3 or higher: severe). (Source: Guidelines for the Use of Antibiotics in Adult Community-Acquired Pneumonia, 2017)
□ To improve the quality of pneumonia diagnosis and treatment and ensure that patients across the country receive appropriate and high-quality medical care, HIRA has been conducting adequacy evaluations for pneumonia and publicly releasing the results since 2014.
□ The overall average score for this evaluation was 82.9 points, with tertiary hospitals scoring 99.2, general hospitals scoring 92.2, and hospitals scoring 66.8, indicating variation by institution type.
○ Based on the overall scores, institutions were classified into five grades. A total of 311 institutions received a Grade 1 rating, distributed across all regions nationwide.
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< Regional Distribution of Grade-1 Medical Institutions > | ||||||||
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(Number of institutions, %) | ||||||||
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Region |
Nationwide |
Seoul |
Gyeongin |
Gangwon |
Chungcheong |
Jeolla |
Gyeongsang |
Jeju |
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Overall |
599 |
61 |
126 |
26 |
56 |
124 |
199 |
7 |
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Grade 1 |
311(51.9) |
44(72.1) |
73(57.9) |
9(34.6) |
28(50.0) |
53(42.7) |
98(49.2) |
6(85.7) |
□ In the 6th evaluation, both the number of institutions evaluated and the number of cases increased compared to the 5th evaluation. However, the 5th evaluation showed a different trend from previous rounds, as the number of eligible cases* significantly decreased due to the impact of the COVID-19 pandemic. Therefore, the 6th evaluation results were compared with those of the 4th evaluation, which had a similar scope of evaluation.
*5th evaluation: (evaluation period) Oct 2021 – Mar 2022; (420 institutions, 15,075 cases)
□ The evaluation consisted of five indicators:
▲ (Testing Domain) Rate of oxygen saturation testing, use of severity assessment tools, rate of sputum culture test orders, and rate of blood culture testing before the first antibiotic administration;
▲ (Treatment Domain) Rate of appropriate first antibiotic administration within 8 hours of hospital arrival.
All indicators showed improvement compared to the 4th evaluation.
○ The rate of oxygen saturation testing recorded the largest improvement, rising to 96.4%, a 14.5 percentage-point increase from 81.9% in the 4th evaluation.
- For severe pneumonia cases, hypoxemia may occur, making it essential to assess the patient’s condition and determine whether oxygen therapy is necessary.
○ The use of severity assessment tools increased to 83.6%, up 11.7 percentage points from 71.9% in the 4th evaluation.
- Objective criteria for assessing disease severity are necessary to decide whether hospitalization or intensive care unit treatment is required.
○ The rate of sputum culture test orders was 82.0%, and the rate of blood culture testing before the first antibiotic administration (among all blood culture cases) was 95.0%, representing increases of 0.4 and 1.1 percentage points, respectively, compared to the 4th evaluation.
- Since the pathogens causing pneumonia vary, identifying the causative organism and using appropriate antibiotics are essential for effective treatment.
○ The rate of appropriate first antibiotic administration within 8 hours of hospital arrival—an integrated indicator* introduced from the 6th evaluation—was 93.2%.
*This indicator integrates two previous measures: “Rate of antibiotic administration within 8 hours of hospital arrival” and “Appropriateness of initial antibiotic selection.”
- Rapid administration of appropriate antibiotics in the early stage of hospitalization is recommended, as studies report that early antibiotic use reduces mortality.
□ Director Jeon Mi-ju of HIRA’s Evaluation Operations Office stated, “As pneumonia is a major health concern among the elderly, we will continue to enhance the quality of treatment through pneumonia evaluations and contribute to building a safer medical care environment.”
